Question
A 63-year-old man comes to the physician because of a 1-month history of difficulty swallowing, low-grade fever, and weight loss. He has smoked one pack of cigarettes daily for 30 years. An esophagogastroduodenoscopy shows an esophageal mass just distal to the upper esophageal sphincter. Histological examination confirms the diagnosis of locally invasive squamous cell carcinoma. A surgical resection is planned. Which of the following structures is at greatest risk for injury during this procedure?
| A. |
Esophageal branch of thoracic aorta
|
| B. |
Left inferior phrenic artery
|
| C. |
Inferior thyroid artery
|
| D. |
Left gastric artery
|
Show Answer
|
Correct Answer � B
Explanation
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|
Answer B) Left inferior phrenic artery
This patient presents with squamous cell carcinoma in the cervical portion of the esophagus.
Inferior thyroid artery
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The inferior thyroid artery originates from the thyrocervical trunk (left) or subclavian artery (right).
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It supplies the cervical portion of the esophagus, which is 6–8 cm long and extends between the hypopharynx (lower border of the cricoid cartilage) and the thoracic inlet (suprasternal notch).
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Since this tumor is located in the cervical portion of the esophagus, care should be taken to avoid injuring this artery during the surgery.
Esophageal branch of thoracic aorta
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The esophageal branch of thoracic aorta supplies the thoracic portion of the esophagus, which extends between the thoracic inlet and the gastroesophageal junction.
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A different structure is at higher risk of injury given the location of the mass.
Left inferior phrenic artery
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The left inferior phrenic artery originates from the aorta and supplies the abdominal portion of the esophagus, which is located below the esophageal hiatus of the diaphragm.
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A different structure is at higher risk of injury given the location of the mass.
Left gastric artery
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